There are groundbreaking therapies on the horizon. But they won’t get to the people who need them without significant change.
The new FDA-approved drugs coming to market are a breakthrough for millions of people at-risk for, or in the earliest stages of, Alzheimer’s disease, and for their providers. It’s estimated that nearly one-in-ten Americans aged 65+ may have some form of dementia, but almost 60% of that population are undiagnosed. The raw number of people affected by this disease continues to climb as Baby Boomers turn 65 in record numbers. Until now, the absence of promising drug therapies, and the systemic limitations of screening for cognitive decline, have stymied a response to the growing Alzheimer’s public health crisis.
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These drugs present novel treatment options to slow the progression of the disease for the first time – with a catch. For new disease-modifying drugs targeting beta amyloid (the plaques associated with Alzheimer’s) to work, they need to be given during the early stages of the disease. That is only possible through early detection of cognitive impairment and an Alzheimer’s diagnosis soon after that. Right now, half of Alzheimer’s patients aren’t diagnosed until they’re in the moderate-to-severe stages of disease. There is an urgent need for health systems to put a routine, standardized cognitive screening process in place, identifying prevalence and enabling providers to allocate resources and prescribe medication to those who could benefit. If only the system worked to bring them within reach. Here are three ways to change all that.
Debrief on the breakthroughs
Systems can begin by briefing care teams about the latest technology and therapeutic intervention research. There are as many as 100 disease-modifying treatments for Alzheimer’s at various stages of regulatory approval or in clinical trials, but fewer than one-in-four primary care providers (PCPs) say they are familiar with the developments.
Digital innovation has improved upon traditional paper and pencil assessments (MoCA, SLUMS, MMSE) by drastically reducing the time to test, removing bias and subjectivity, and minimizing training to administer. Limited experience in performing cognitive assessments has been a prevailing barrier for PCPs. These advancements in low-cost, non-invasive cognitive screening methods allow for seamless integration into the patient’s annual wellness visit. In practice, health systems can use digital screenings to help more patients move to diagnosis with much greater efficiency.
A Personalized Approach to Medication Nonadherence
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Furthermore, multiple studies by organizations including the WHO have established the cognitive health benefits of lifestyle behaviors regarding diet, sleep, exercise, stress management, social engagement and intellectual activity. The evidence that behavior change can protect against Alzheimer’s and dementia offers providers another option for patients who don’t yet have cognitive impairment but might be at risk.
Encourage “the talk”
PCPs can talk to their patients about the importance of early screening and medical advances that are turning Alzheimer’s into something more like a manageable chronic disease than a death sentence. People are generally unaware about modifiable risk factors, or the benefits of early detection and new drug therapies. This contributes to patients’ reluctance to raise concerns with their providers. Increased therapeutic and screening awareness is a key step towards giving providers confidence to support patients with preemptive action.
Screen proactively
Finally, health systems need to offer screenings at scale. Historically, our healthcare system hasn’t had the tools for standardized, population-scale screening, and surveys indicate that PCPs typically don’t offer them unless patients or their families ask for it. But emerging digital cognitive screening has the potential to address this need with technology that can transform how cognitive health is managed. Health systems can make this a regular practice for all patients aged 65+, eliminating the friction of making individuals feel singled out by suggesting it.
Following screening, providers can determine whether further workup is needed to provide a diagnosis to low-scoring individuals, or if a normal-scoring patient should work on reducing risk factors and track performance over time. Routine screening, and by extension, detecting true dementia prevalence within a population, is also a path to optimizing care and maximizing reimbursement by allocating resources to the affected population.
We need health systems to be the engine driving a breakthrough, taking a proactive approach to cognitive health. PCP’s relationships with patients in every age group make them, potentially, the single most effective force in treating cognitive disease. As more life-extending medications come on the market, health systems have a responsibility to make meaningful changes in how they screen and reach older adults. Earlier detection could mean millions of individuals enjoy longer lives of good cognitive health.
Photo: wildpixel, Getty Images
Jordan Glenn, Ph.D., is the Chief Science Officer of Neurotrack Technologies. He has developed a diverse background in the digital health space where he has used his expertise in exercise, nutrition, aging and behavior change to focus on disease states such as diabetes, cardiovascular disease, and now Alzheimer’s and dementia. As Neurotrack’s Chief Science Officer, he leads the company’s scientific pipeline, while also informing the company's business development/ partnerships. He also holds an academic dual-appointment at the University of Arkansas and has been authored on over 80 scientific publications. He is also the primary investigator on the DC-MARVEL project, which is the first study ever to investigate the effects of fully remote, digital health coaching on Alzheimer’s disease risk.
In February 2023, Glenn delivered Neurotrack’s winning pitch in the Alzheimer’s Association Pitch Competition, aimed at identifying innovations to increase cognitive assessment and early detection and diagnosis of dementia within primary care settings.
